|Weight: 70 kg. | |Height: 1.70m. |

|Main symptom: |pain in the right lower quadrant (sporadic and|

| |colicky in nature) |

| |*began in epigastrium two days ago |

| |*moved to periumbilical region and right lower|

| |quadrant |

|Other symptoms:|fever, vomits (3), anorexia, constipation for |

| |two days (no bowel movement). No diarrhea |

|Past history: |-none |

|Family history:|-none |

|Toxic habits: |-none |

|Medications: |-none |

|Physical |-patient well oriented as to time, place and |

|findings: |person |

| |-well nourished |

| |-extreme tenderness to palpation mainly |

| |over McBurney's point |

| |-guarding, muscle rigidity, rebound |

| |tenderness |

| |-difference: axillary & rectal temperature |

| |-bowel sounds: absent |

|Definitive diagnosis: acute appendicitis |

|Therapeutic procedures: appendectomy |

|Possible complications: perforation, necrosis, peritonitis |

|Prognosis: Anceps |

Report

Today we discussed the case of a 22-year-old white man who was in good

health prior to two days ago, when he began to have an abdominal pain. This

pain was sporadic and colicky in nature. It began in the epigastrium and

has since migrated to the right lower quadrant. The patient has had three

episodes of vomiting associated with the pain. He has been anorectic and

feverish. He has had no bowel movements for two days. He reported no

diarrhea, coughing with expectoration or shortness of breath. He has no

past history or family history of abdominal pain or any other disease. The

pertinent physical findings are related to the abdomen. There is extreme

tenderness to palpation, especially over McBurney's point. Guarding, muscle

rigidity and rebound tenderness are all present. Bowel sounds are absent.

There is a difference between the axillary and the rectal temperature. His

urinalysis, hemoglobin and hematocrit are within normal limits.

Nevertheless, both white blood count and red rate are elevated. His chest

film is clear, but in the abdominal film we observed the psoas line is

absent.

Finally, we decided the definitive diagnosis is acute appendicitis. Among

the possible complications to consider are perforation, necrosis and

peritonitis. Therefore, the prognosis is anceps. The only possible

treatment is surgical: appendectomy.

Conclusion

As we have seen, there are numerous opportunities to help students develop

the skill of note-taking. Note-taking assists the listener, reader, or

observer in achieving a better understanding of what is presented, and it

facilitates recall of facts as well as oral and written expression. The

student's language level and the purpose which the notes are to serve will

determine the type of guidance the teacher must provide to help them to

take notes in class and later on the job.

Grammar games

Competitive games

Speed

|Grammar: |Collocations with wide, narrow, and broad. |

|Level: |Intermediate to advanced |

|Time: |15-20 minutes |

|Materials:|Three cards, with wide on one, narrow on the second and|

| |broad on the third |

Preparation

Prepare three large cards with wide on one, narrow on the second and broad

on the third.

In class

Clear as much space as you can in your classroom so that students have

access to all the walls and ask two students to act as secretaries at the

board. Steak each of your card on one of the other three walls of the room.

Ask the rest of the students to gather in the middle of the space.

Tell the students that you’re going to read out sentences with a word

missing. If they think that the right word for that sentence is wide they

should rush over and touch the wide card. If they think the word should be

narrow or broad they touch the respective card instead. Tell them that in

some cases there are two right answers (they choose either).

Tell the secretaries at the board to write down the correct versions of the

sentences in full as the game progresses.

Read out the first gapped sentence and have the students rush to what they

think is the appropriate wall. Give the correct versions and make sure it

goes up in the board. Continue with the second sentence etc.

At the end of the strenuous part ask the students to tale down the

sentences in their books. A relief from running! ( If the students want a

challenge they should get a partner and together write down as many

sentences as they remember with their backs to the board before turning

round to complete their notes. Or else have their partner to dictate the

sentences with a gap for them to try to complete.)

Sentences to read out

|They used a … angled lens |Wide |

|He looked at her with a … smile |Broad |

|The socialists won by a …. Margin |Narrow/broad |

|She is very … minded |Broad/narrow |

|He speaks the language with a … |Broad |

|London accent | |

|You were wrong what you said was … of|Wide |

|the mark | |

|You had a … escape |Narrow |

|Of course they’re … open to criticism|Wide |

|They went down the canal in a … boat |Narrow |

|She opened her eyes … |Wide |

|The news was broadcast nation … |Wide |

|The path was three meters … |Wide |

|The light was so bright that she … |Narrowed |

|her eyes | |

Variation

You can play this game with many sets of grammar exponents:

. Forms of the article; a, the and zero article

. Prepositions

Etc.

Cognitive games

Spot the differences

|Grammar: |Common mistakes |

|Level: |Elementary |

|Time: |20-30 minutes |

|Materials:|One copy of Late-comer A and Late-comer B for each |

| |student |

In class

Pair the students and give them the two texts. Ask them to spot all the

differences they can between them. Tell them that there may be more than

one pair of differences per pair of parallel sentences. Tell them one item

in each pair of alternatives is correct.

They are to choose the correct form from each pair.

|Late-comer A |Late-comer B |

|This women was often very late |This woman was often very late |

|She was late for meetings |She was late for meeting |

|She were late for dinners |She was late for dinners |

|She was late when she went to |She was late as she went to the |

|the cinema |cinema |

|One day she arrive for a meeting|One day she arrived for meeting |

|half an hour early |half ah hour early |

|Nobody could understand because |Nobody couldn’t understand why |

|she was early |she was early |

|‘Of course,’ someone said, |‘Of course,’ someone say, ‘the |

|‘clocks put back last night.’ |clocks were put back last |

| |night.’ |

3. Ask them to dictate the correct text to you at the board. Write down

exactly what they say so students have a chance to correct each other both

in terms of grammar and in terms of their pronunciation. If a student

pronounces ‘dis voman’ for ‘this woman’ then write up the wrong version.

Only write it correctly when the student pronounces it right. Your task in

this exercise is to allow the students to try out their hypotheses about

sound and grammar without putting them right too soon and so reducing their

energy and blocking their learning. Being too kind can be cognitively

unkind.

Variation

To make this exercise more oral, pair the students and ask them to sit

facing each other. Give Later-comer A to one student and Late-comer B to

the other in each pair. They then have to do very detailed listening to

each other’s texts.

Feeling and grammar

Typical questions

|Grammar: |Question formation-varied interrogatives |

|Level: |Beginner to elementary |

|Time: |20-30 minutes |

|Materials:|None |

In class

1. Ask the students to draw a quick sketch of a four-year-old they know

well. Give them these typical questions such a person may ask, e.g.

‘Mummy, does the moon go for a wee-wee?’ ‘Where did I come from?’. Ask

each student to write half a dozen questions such a person might ask,

writing them in speech bubbles on the drawing. Go round and help with the

grammar.

2. Get the students to fill the board with their most interesting four-year-

old questions.

Variations

This can be used with various question situations. The following examples

work well:

- Ask the students to imagine a court room-the prosecution barrister is

questioning a defense witness. Tell the students to write a dozen questions

the prosecution might ask.

- What kind of questions might a woman going to a foreign country want to

ask a woman friend living in this country about the man or the woman in the

country? And what might a man want to ask a man?

- What kind of questions are you shocked to be asked in an English-speaking

country and what questions are you surprised not to be asked?

Achievements

|Grammar: |By+time-phrases Past perfect |

|Level: |Lower intermediate |

|Time: |20-30 minutes |

|Materials:|Set of prepared sentences |

Preparation

1. Think of your achievements in the period of your life that corresponds

to the average age of your class. If you’re teaching seventeen-year-olds,

pick your first seventeen years. Also think of a few of the times when

you were slow to achieve. Write the sentences about yourself like these:

By the age of six I had learnt to read.

I still hadn’t learnt to ride a bike by then.

I had got over my fear of water by the time I was eight.

By the time I was nine I had got the hang of riding a bike.

By thirteen I had read a mass of books.

I’d got over my fear of the dark by around ten.

2. Write ten to twelve sentences using the patterns above. If you’re

working in a culture that is anti-boasting then pick achievements that do

not make you stand out.

3. Your class will relate well to sentences that tell them something new

about you, as much as you feel comfortable telling them. Communication

works best when it’s for real.

In class

1. Ask the students to have two different colored pens ready. Tell them

you’re going to dictate sentences about yourself. They’re to take down

the sentences that are also true for them in one color and the sentences

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